By Elizabeth Zach, staff writerRuralHospitals

Rural residents tend to be older, sicker and poorer than city dwellers, according to Diane Calmus government affairs and policy manager at the National Rural Health Association (NRHA). However, since 2010, the number of rural hospitals has markedly decreased, and in more recent years, continues to see a steady decline in services.

Moreover, rural residents “are much more reliant on Medicaid and Medicare. So cuts to those programs, along with regulatory burdens on rural hospitals are hitting these hospitals hard,” Calmus said in an article on According to the NRHA, 440 rural hospitals closed between 1983 and 1988, when it became common to charge a set fee for services versus reimbursement for actual costs. In 2011, Medicare payments were cut by 2 percent, and in 2012, additional cuts of up to 35 percent further stressed the nation’s hospitals.

Local economies also feel the pain.

“The impact on these communities when hospitals close is huge,” Calmus said. “The average rural critical access hospital alone creates around 195 jobs and generates about $8.4 million in payroll annually.” And when a hospital closes, the doctors leave and don’t return, she adds.

Reps. Sam Graves (R-Mo.) and Dave Loebsack (D-Iowa) introduced a bill in July which could be a possible solution by. It would prohibit Medicare and Medicaid cuts to rural hospitals and would also reclassify them as so-called Community Outpatient Hospitals, which would focus on outpatient services and primary care.

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